20318APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification
Building Address: 1
PFRMITNO.
10100 Torre Ave., Unit 118 (H1.1)
20318
rareName: ane:
A
Tnum Center Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
5/09/90
Contractor's Name: Lic. N.
738-4444
BUILDINr—EL2CTMCALPLUMBINGMECHANICAL
CATEGORY
CONTROL#
Architect/Engineer: Lie. No:
QTY ELECfRICPERMIT FEE
BUILDING PERMIT INFO
Addreec
® ,®
PFRMITISSUAN'CE 12
Wm ED CONTRACTOR'S DECLARATION
that
I WrecctfoAmlhatlamllcrnud under pessandaof ChionsCommmn
inenseISemon for0)ofddied.3oftheBupnessand Pro(esponsCode,and my
ss Is In full (cam and
APPLIANCESRESIDENML
JOB DESCRIPTION
a.... D
PANELS
cf #
Lice
Licence Ckn
1` I(�
Date Contractor
Cord
201-IODUAMPS
ARCHITECT'S DECLARATION
I understand my pars slug be used as public records.
OVER 1000 AMPS
SQ. FT. FLOOR AREA
$/SQ. Fr.
SIGNSELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contracorb Linos Law for the
805
74.92
SPECIAL CIRCUIT/MISC
TEMP, METER OR POLE INST.
following reason. (Section 7BIIS, Busmeiand Profeniuns Code: Any city or
countywhich requi'es a pcmnit tomrasbuct, alter, bnpmve, dennikh,ereepair
anystmctumpel toiaL ame,akorequlmtheappB.ntforsuchper tto
file a signed statement that he is licensed pursuant to the provision, of the
POWER DEVICES
SWIMMING POOL ELECTRIC
Contractor's License Law (Chapter9(commencing with Section 7000) of Divi.
sion3 of the Business and ProfegkmACcde) or that he is exempt therefromand
VALUATION
the bank for the alleged exemption. Any violation of Section 7011.5 by any
applicant fora permit subjects the applicant to a civil penalty of not more than
OIRLETS�SWITCHESFIXfURFS
$ 60 311.00
s
five hundred dollars ($500).
as owner of the property, or my employees with wages as their wk
NEWRFSIDENTIALELECTR SQ.FT.
STORIES
TYPE CONSTRUCTION
compensation,
compensation, wlldothe work and thestructure k not intended or offered for
sale (Sec. 7044, Business sad Professions Code: The Contractors Licerce Law
V -N
dons not apply to an owner of property who builds or improves thereon and
who donsuchwork himselforthrough Ms own employees, provided that such
OCC. GROUP
RFS. UMTS
improvements are not intended oroffered for sale. 14 however, the building or
Improvement is sold within one yearofcompletion, the owner-builderwill have
TOTAL:
. ,
R-3
tlW.Ifurden of proving that he did not build or improve for purpose of sale.),
u L as owner of the property, am exclusively contracting with limned
contractors to construct the project (Sm 7074, Students and Profusions Code:
I'y, .', p _,PLUMBING PERMIT. FEE'.',
FLOOD ZONE
APN
PERMIT ISSUANCE
The Contractors License Lew don not apply to an owner of property who
Wilds or Improves thereon, and who contram for such projects with a
to the Contnctol, Ll.neIs Law'
cgagactor(eexem t under
LL�J I am exempt under see B & P C for this reason
ALTER -DRAIN & VENT - WATER (EA'
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECEIPT It
Owner Data
WORKMAN COMPENSATION DECLARATION
C31 hereby allrm that I have a certificate of consent to ul4lnsure, or a
certificate of Worken'Comperuatien Imuran. ora.rtlfied copythemof (Sec.
3800, Lab C.)
Policy
FDCTURFS� PER TRAP
SCITOOL TAX Y N
RECEIPT M
GAS FA.SYST'EM-11NC.40ITILEIS
PARK FEE Y_ N_
RECEIPT #
It
Comm r�ny
GAS EA. SYSTEM -OVER 4 (EA)
BUILDING DIVISION FEES
�IGertiOed mpykhereby furnlehed. -
I'�JF`unified copy is filed :with the city Inspection division.
CREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
..
CREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
Qhis section need not W completed if the permit kfm ane hundred dollars
Date RCOeI t71
SEWER -SANITARY SR7RM EA Z00FT
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N
(Sl00)orless.)
IcertifythatNNe performance o(thewmkfor wMch W,permit klssued,
WATER SYSTEM/TREATING
I shall not employ any person in any manner An as to become subject to the
Worken'Compensadon Laws of Calfomk. Date
PAID
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers' Comperout Ian provisions of the Labor
NEW RESIDENTIAL PLMB. SQ.FT.
Date Rec'el til
TOTAL:
BUILDING FEE
464.00
Code, you moat forthwith comply with such proigoes or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
4./j
IM1erebyaffirm thatlWrckamm[roctlon lending agency for the perform
onceof the work forwhich this permit k issued (Sec. 3097, Civ. C.)
Lender. Name
Iendcrl Address
I certaythat] haveread thkapplicalionand mate that theabove mfomutlon
I, cosset. l agmto comply with all cityand county ordinances and pate law,
TOTAL:
ELECTRIC FEEL
PLUMBING FEE
32.1
s:
QTY., i,. IVIECFIANICA TERMIT-'FEE'i'L
MECHANICAL FEE
12
PERMIT ISSUANCE 12
FEES PAID:
relating to building comtrudion, and hereby authodre mpreaenlatives of this
city to enter upon the above-mentloned property for Inspection purpose..
(We)agreeto ssvelnderradfys,casm anexpkeep
es which the inCity
anywyAccrue
agalnt IablBtin, judgments, cope and expense which may In anywayamue
ALTERORADDTOMECH.
Date Receipt#
AIR HANDLING UNIT 10,000 CFM)
SUBTOTAL:
agairstsaid CC aeon f ty&S'pting of this permmit�
/wr
A[RIiANDLINGUMT(OVFRIO,OWCFM)
CONSTRUCTION TAX
a"
41/%�a�Ja
signs ma/AppB.nt/Contractor % to
EXHAUSTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
hof
HAZARDOUS MA ALS DI SCLOSU RE
Will the applicant or future building occupant store or hand Is hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.17, and the
❑tYndStfetyCode,Secoon25533(a)t _
HEATING UNIT (TO 100,000 BTU)
Date Recei t>f
HEATING UNIT (OVER ]00,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
PAID'
Will the applicant or future building occupant use equipment or devices
which eat harardous air contaminants as defined by the Bay Area Air
slily Management District?
yea No
BOILER -COMP 0) POR IMOOD BTU)
BOfLER-COMP(OVER 100,000 BTU)
have read the huzar�acutsnaterial, requirements under Chapter 6.95 of
the California Health&SafyCode, Sections 25505,25533 and 15534. 1
understand that lithe Wilding does not currently have a tenant, that it Is my
NEW RESIDENTIAL MECI. SQ.FT.
responsibility to notify the ocu pant of the requirements which rust W met
prior to issuarm of a Certificate of Occuipa ncy.
#� .'
City of Cl IRp11y 1PA
ISSUEDBY: C ,
Owner or authorircd agent Data
TOTAL:
OFFICE COPY